Breast reconstruction is a surgical procedure that utilizes different techniques
to create a breast that closely matches the shape, size and feel of the breast
that was removed. There are two alternatives to consider: immediate breast reconstruction
and delayed breast reconstruction.

Immediate
breast reconstruction is performed at the same time as the mastectomy,
while delayed breast reconstruction is postponed until a later
post-surgery date.

Breast
reconstruction is most often recommended for patients who have
undergone a mastectomy (surgical removal of a breast) due to
cancer or a pre-cancerous condition, although these techniques
may also be used to correct any type of breast abnormality.

Many
women feel insecure about breast abnormalities, especially after
a mastectomy. Breast reconstruction offers women an opportunity
in renewing a normal appearance to their breasts. This will create
a sense of confidence as well as assist the woman in regaining
her femininity.

During
immediate reconstruction the general surgeon, who removes the
breast, teams up with a Plastic Surgeon, creating the new breast.
Immediate reconstruction has several potential emotional and
aesthetic advantages. Some patients find that waking up from
a mastectomy with two normal breasts helps to alleviate the grief
caused by losing a breast. Immediate reconstruction can also
preserve a greater amount of skin and reduce scarring. Scars
are easier to conceal when less skin is removed during the mastectomy.
And, of course, when the reconstruction is performed immediately
following the surgery, there is only one recovery to deal with.

Delayed
Reconstruction

Though
immediate reconstruction offers many benefits, it is not for
everyone. Some patients do not want the added stress of researching
different reconstruction techniques while they are coping with
a cancer diagnosis. Since breast reconstruction can be performed
weeks or even years after having a mastectomy, choosing a delayed
reconstruction allows patients to take their time exploring their
choices. Delayed reconstructions also allow patients to complete
other treatments such as chemotherapy or radiation before thinking
about breast reconstruction.

If
you are considering breast reconstruction, the following information
will provide you with a good introduction to the procedure. For
more detailed information about how this procedure may help you,
we recommend that you consult a plastic surgeon who is board
certified or who has completed a residency program that includes
instruction in this procedure.

There
are two major types of breast reconstruction: breast implants
and flap reconstruction:

Breast
implants

The
most common breast reconstruction technique, implants are rubber
shells filled with either silicone gel or a saline solution.
Breast implants are typically inserted through the use of a tissue
expander. In this technique, a silicone balloon or bag is surgically
placed beneath the chest muscle.

Through
a valve buried under the skin, the surgeon injects a sterile
saline solution into the bag, expanding it. The "expander" stays
in place for several weeks or months, during which time weekly
or bi-weekly injections are administered. Once the skin has expanded
sufficiently, the bag is replaced with a permanent implant during
a second surgery.

A
third surgery may be recommended to reconstruct the nipple and
areola. In order to ensure proper placement of the nipple, this
operation is normally performed at least three weeks after implant
surgery, giving time for the new breast time to settle into its
permanent position. The nipple is usually fashioned from a small
piece of skin drawn from the breast mound. A separate skin graft
forms the areola. About six weeks later, the nipple and areola
will be colored to match the other side using a medical tattoo
technique.

This
technique creates a new breast using a section of muscle, skin
and fat taken from another area of the body. It requires a longer
hospital stay and more recovery time than implant reconstruction,
and it also leaves scars at both the breast site and the donor
site. But because the new breast is made of natural tissue, it
looks, feels and ages more like a normal breast -- which many
patients prefer. In addition, the use of natural tissue eliminates
the complications that can arise when foreign objects such as
implants are inserted into the body. Flap reconstruction may
also be recommended when the skin won't expand enough to cover
an implant.

Flap
reconstruction may be performed using a pedicle flap or a free
flap. The pedicle flap allows the tissue used in reconstruction
to remain attached to its original blood source. The tissue is
moved to the breast area through a tunnel under the skin. In
the free flap technique, the flap tissue is completely removed
and reattached to the breast area, where its blood vessels are
connected to those in the chest area through microsurgical techniques.

The
TRAM procedure can be performed as either a pedicle flap or a
free flap. A section of muscle, fat and skin is surgically removed
from the abdomen and used to form the new breast. Sometimes referred
to as "tummy-tuck" reconstruction, this procedure flattens
the stomach andreconstructs the breast simultaneously. After
the surgery, the abdominal muscles are temporarily weakened,
and in rare cases, this weakness becomes permanent. If you are
considering future pregnancy, be sure to tell your doctor because
this sort of abdominal weakness can affect future pregnancy.

Latissimus
Flap

In
this technique, a section of the latissimus dorsi (the back muscle
arising from the top of the hip to the arm just below the shoulder)
is removed to form a new breast. This tissue is often quite thin,
so a small implant may be required as well.

Other
flaps

If
the abdominal or latissimus tissue is unsatisfactory, a flap
can be taken from the upper, middle or lower part of the buttock.
However, this technique tends to weaken the gluteal muscle, restricting
an athletic patient's activities. It also requires the surgical
removal of a vein from one leg, since the gluteal blood vessels
often aren't long enough to stretch from the chest area to the
armpit where they must be reattached. If all other methods are
unsatisfactory, tissue can be taken from the upper hip or "love
handle" area. This technique is usually a last resort, since
this tissue does not lend itself well to shaping a breast. Taking
a flap from this area can also leave the hips uneven.

Generally,
each of the surgeries in the implant process takes from one to
two hours. Flap reconstruction surgeries may take two to four
hours and the TRAM flap operation could take up to six hours.
Free flap procedures are often longer than pedicle flap procedures
because of the careful microsurgery needed to reconnect the blood
vessels.

What
type of anesthesia is used?

Breast
reconstruction is performed using general anesthesia causing
you to be asleep during the whole procedure.

Breast
reconstruction is usually performed on an outpatient basis, in
the surgeon's office-based surgical suite, an outpatient surgical
facility, or hospital.

When
can I return home and resume normal activities?

Tissue
expansion and implants are often done on an outpatient basis,
allowing the patient to return home immediately. On rare occasions,
patients may be slow to recover from anesthesia or have complications
that require them to stay overnight in the hospital.

During
your initial consultation, your surgeon will discuss the changes
that you would like to make to your appearance. Since the appearance
of your breasts is a matter of personal perception and preference,
you will need to discuss your concerns in detail so your surgeon
can determine the appropriate alternatives. You also should make
arrangements ahead of time for someone to drive you to and from
your procedure and to assist you with your daily activities during
your recovery period.

Prior
to your surgical procedure, the surgeon will perform a complete
health history and physical. Depending on your age and state
of health, your surgeon may order tests including, but not limited
to, an electrocardiograph (ECG), chest x-ray and spirometry (lung
function test). Knowledge of your allergies, medications and
previous surgeries should be brought to your surgeon's attention
at this time. Specific instructions to assist you in preparing
for this procedure will be given to you after the health history
and physical is complete. Depending on your individual health
status, the instructions may include guidelines regarding your
diet, alcohol intake, smoking and which medications.

Recovery
time varies depending on the type of procedure, but usually takes
between four and six weeks. Recovery from flap procedures generally
takes longer than recovery from implant procedures. You should
be able to do light activities by the end of the first week,
including taking short walks to reduce the risk of blood clots
in the legs. Refrain from heavy lifting, sexual activity and
rigorous sports for three to six weeks. Patients who have had
the TRAM flap procedure should refrain from heavy lifting for
at least three months, since the abdominal wall is weaken by
the procedure and further strain could result in a hernia.

What
are the possible complications after breast reconstruction
surgery?

The
most common problem following implant surgery is capsular contraction,
a tightening of the scars around the implant. In this situation,
a second surgery can be performed to loosen the scar tissue.
Other complications associated with implants include infection
around the implant, necessitating its removal, and leaking, hardening,
or shifting of the implant.

You
should know that implants deteriorate over time and may eventually
need to be replaced. With all free flap procedures there is a
risk that the blood vessels will not reattach sufficiently, constricting
blood flow and causing the death of the flap tissue. Flaps taken
from the buttocks can result in a weakened gluteal muscle, and
flaps taken from the hips can result in noticeable asymmetry.
TRAM flap procedures can result in abdominal hernia, loss of
feeling in the skin below the navel, and a permanent weakening
of the abdominal muscles. As with most surgeries, the risks of
swelling, bleeding, infection, fluid collection, drug reactions,
keloid scarring, and numbness exist. No procedure is without
risks; however, the majority of complications known to be associated
with a breast reconstruction are minor when the procedure is
performed by an experienced board certified plastic surgeon.
It is always important to be informed about the possible complications
before any surgery. Be sure to discuss any concerns you may have
with your surgeon.

Most
patients report that breast reconstruction enhances their appearance
and contributes to their quality of life. Scars will never completely
disappear, but they do fade with time. You should also be aware
that a reconstructed breast may not duplicate the other breast
exactly; it may seem firmer and have a slightly different shape.
For most patients, these factors do not detract from their overall
satisfaction with the replacement of a lost breast
After surgery you will be tired and sore for one to two weeks. Your doctor
can prescribe pain medication to relieve any discomfort. You should also expect
some swelling and bruising, which could last for several weeks. Some procedures
require the insertion of a drain for at least a week to remove excess fluid
from the surgical site. Your stitches will either dissolve or be removed within
ten days of surgery.

For
the first twenty-four to forty-eight hours after surgery, you
can apply ice to the area every fifteen minutes to reduce pain
and swelling. After a tissue expansion or implant procedure,
you'll be allowed to bathe again beginning twenty-four hours
after the surgery. After flap surgeries, sponge baths are advised
for about a week.
Having a breast removed can cause great emotional strain. For patients whose
mastectomy was due to cancer, the absence of a breast can be a daily reminder
of their struggle with a serious disease. Breast reconstruction can give patients
a physical appearance similar to that before their mastectomy, or, when it
is used to correct deformity, it can create symmetry that in the body that
was lacking before the surgery. Breast reconstruction can help restore women's
self-confidence, femininity and sense of wholeness, so that they can go on
with their lives.

Some
insurance companies will pay for breast reconstruction if it
is medically necessary, but they may have specific requirements
such as a letter from your surgeon, a referral from your general
practitioner, and/or photos or other documentation. Be sure to
find out what your insurance company requires if you intend to
use insurance to pay for this surgery.

We at Beverly Hills Plastic Surgery Specialists are here to help you
make an informed and educated decision. The information presented
on this website can help answer some of your questions, however
for more detailed information related to your specific needs we
recommend meeting with a highly qualified and experienced board
certified plastic surgeon for a consultation. When you feel ready
to meet with a cosmetic surgeontgive us aCall
Toll Free (800) 449-1884 or you can send us a request
for a consultation with a platic surgeon in Beverly Hills.